Advance care planning among older cancer survivors in the United States.

Abstract

91 Background: The goal of advance care planning (ACP) is to ensure that end-of-life (EOL) care is consistent with patient wishes and preferences. The ACP is particularly relevant to older adults with cancer due to their high risk of mortality. However, it remains unclear whether older cancer survivors have a higher rate of ACP engagement than general older adults. Methods: We used data from the National Health and Aging Trends Study (NHATS) Round 8, a nationally representative study of adults aged ³65. This cross-sectional analysis included 4,666 participants (1,568 cancer survivors), representing 33.93 million older Americans in 2018. The ACP was defined as having any of the three self-reported elements of ACP: EOL discussion, durable power of attorney (DPOA), or living will/advance directive. Cancer survivors were identified by self-reported cancer in Round 8 or prior rounds. Covariates were self-reported, including age, sex, race, marital status, education level, income, number of comorbidities, number of limitations in activities of daily living (ADL) and probable/possible dementia. We used logistic regressions to examine the association of cancer diagnosis and ACP engagement, adjusting for covariates and complex survey design and weights. Results: Older cancer survivors reported a higher rate of ACP engagement (80.10% vs 73.39), EOL discussion (66.94% vs 60.92%), DPOA (58.56% vs 51.02%) and living will/advance directive (63.34% vs 52.81%), compared to older adults without cancer. However, in adjusted logistic models, there was not significant difference between the two groups in ACP engagement (adjusted OR=1.12, 95% CI: 0.93, 1.36, P=0.22), EOL discussion (adjusted OR=1.08, 95% CI: 0.91, 1.29, P=0.37), DPOA (adjusted OR=1.07, 95% CI: 0.90, 1.28, P= 0.42) or living will/advance directive (adjusted OR=1.20, 95% CI: 1.00, 1.45, P=0.05). The oldest old (>80 years), women, White people, single/not married, with higher education, income, comorbidities and ADL limitations were more likely to engage in ACP (all P<0.01). The associations were similar across models that explored the individual elements of ACP. Conclusions: Despite the high mortality risk, older cancer survivors are not more likely to engage in ACP than the general older adults. About 20% of US older cancer survivors have not engaged in any form of ACP. Hospital, clinic and community strategies to introduce and encourage ACP among older cancer survivors are needed, especially for those minority populations.